ABSTRACT
BACKGROUND:
Acute
myocardial infarction in
pregnancy is occasionally due to spontaneous
coronary artery dissection (SCAD). Although uncommon, the majority of cases of
pregnancy-associated SCAD (pSCAD) has critical presentations with more profound defects that portend high maternal and foetal
mortality, and frequently necessitate preterm delivery. This is a case of pSCAD with ongoing ischaemia that required temporary mechanical circulatory support (MCS) and emergent revascularization, while the
pregnancy was successfully continued to early-term. CASE
SUMMARY:
A 30-year-old
woman G2P1 at Week 32 of
gestation with no medical
history, presented to the
emergency department with severe
chest pain. An
electrocardiogram showed ST-segment elevation in the anterolateral leads. An emergent
cardiac catheterization revealed
dissection of the proximal left anterior descending (LAD)
artery with TIMI (thrombolysis in
myocardial infarction) 3 flow. Although initially stable, she later experienced recurrent
chest pain and developed
cardiogenic shock, necessitating MCS, and emergent revascularization. She was stabilized and remained closely monitored in the
hospital prior to vaginal delivery at early-term.
DISCUSSION:
This case of pSCAD at Week 32 of
gestation complicated by refractory ischaemia illustrates the complexity of management, which requires a multi-disciplinary team to reduce both maternal and foetal
mortality.
Conservative management of SCAD, while preferred, is not always possible in the setting of ongoing ischaemia, particularly if complicated by
cardiogenic shock. A thorough weighing of
risks vs. benefits and ongoing discussions among multiple subspecialists in this case allowed for the stabilization of the
patient and subsequent successful early-term delivery.
